Posted by Ignacio H. Valdes, MD, MS on Thursday November 08, 2007 @ 03:09 PMfrom the VistA dept.
A stark future awaits American health care if the Veterans Affairs (VA) system and Cerner is allowed to go forward with announced plans to replace the VA's successful public domain laboratory software, in need of update, with a proprietary one. The VA would give large amounts of cash that would greatly assist a single proprietary company in dominating EHR software in both the public and private sector. A free, thriving EHR ecosystem will be destroyed and replaced with a monopoly or cartel at great expense in which the quality, privacy and security of such software is a trade secret, un-examined and un-examinable. If this is allowed, it could lead to Americans essentially renting their own medical data back from the Cerners of the world at great expense. Digg this article

There are certain things that the government does well. One of these is the VistA Electronic Health Record (EHR) system built by the Veterans Affairs hospital system. Despite numerous past attempts to destroy VistA, the Veterans Affairs health care system has an enviable record of quality care through the open development and use of the only national, truly paperless, proven Electronic Health Record system.

Such is the nature of and complexity of medicine that the VA VistA system took decades of work and a few billion dollars to create. It is a prime example of tax payer money well spent. The software is in the public domain by the freedom of information act (FOIA). It is a major reason that the VA system has gone from one of the worst health care systems to the best and most cost-effective. The VA is the only system that has rigorous quality numbers and research to prove that what they are doing is effective for veterans health. It can do this directly because of VistA and the open nature of the software itself. It is not beholden to a proprietary software vendor to control its destiny.

The VistA software is increasingly being deployed in the private sector because it is effective, because it is comprehensive and because it avoids major issues like monopoly pricing, vendor lock-in, practicing 'black box' medicine and the use of proprietary software systems in medicine whose quality, privacy and security cannot be adequately evaluated and researched.

Despite VistA's winning record and history, the Veterans Affairs system has recently decided to replace a key piece of this system with a proprietary one. The current laboratory system has been effectively in use for decades but has been in need of update for approximately 10 years. Instead of updating it at a comparatively modest cost, the VA is going to ignore software history, ignore the future and ignore taxpayers by removing the VA's current lab system completely and replacing it at a much higher cost with a proprietary one from a company called Cerner.

This is being done in the name of 'modernization'. Unfortunately, this could also destroy VistA, a national treasure, and poison an ecosystem that holds the possibility of unification of Health IT in the United States, a proven system that preserves the quality, privacy and security of health records in the United States.

How is it that this decision can effect the privacy and security of all electronic health records in the US? The VA has a de-facto standard with VistA in an industry that is notoriously difficult to standardize. This de-facto standard created at taxpayer expense is freely available to anyone who wishes to obtain and use it and many are doing exactly that. This system can be directly scrutinized by anyone who wishes to do so without needing permission. It is freedom in its purest form and an essential condition for electronic health record progress. What the VA has already signed on to do with Cerner's unproven and unprovable until it is too late laboratory system is to destroy that de-facto standard and replace it with a proprietary one utterly controlled by a single company.

This is exactly analogous to creating a national system of roads that work well but are now in need of repair at a modest cost, abandoning that system and replacing it at taxpayer expense with roads at ten times the cost. Only these new roads might not work as well and this won't be known until it is too late. These new roads now have toll booths that line the pockets of a proprietary company to pay for more Washington lobbyists in order to make sure that leaders are constantly re-assured of how great the new laboratory system is. In addition, it demolishes a road-building machine that citizens are using to build their own roads at a very modest expense.

The VA signing an agreement with Cerner for its proprietary lab system could be the beginning of the end of a non-proprietary national EHR system that protects EHR privacy, security and quality of care for veterans but also in the private sector because no one but the VA has the resources to update the current non-proprietary VA laboratory system. Privately or publicly deployed VistA systems would cease having laboratory software updates from the VA. Updating of this system by the VA would likely cost pennies on the dollar of taxpayer money rather than replace it entirely with the proprietary Cerner system. Updating the current system would also safeguard privacy and security, avoid vendor lock-in with its monopoly pricing but also ensure that Americans get quality care because the VistA system is constantly researched and scrutinized by medical researchers. Once again, this scrutiny and research is not possible or made remarkably more difficult by using proprietary vendors and is essential to the cost-effective progress of healthcare for Americans.

Imagine a world in which all of your personal medical data is rented from a handful of mega-corporations that can charge whatever they wish for this service. Imagine the US government indirectly destroying the quality, privacy and security of your electronic health records using your tax dollars for an exorbitant amount of money. Far fetched? It is happening now.

I'm appalled (but not surprised) by these developments. As usual, corrupt politicians seem to be involved, and will profit at the expense of people. Suffice it to say that I am bringing this to the attention of people in Canada as well, so you are definitely getting international exposure! :-)